Provider Demographics
NPI:1689088965
Name:HOFMAN, DAPHNE (LMT)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:HOFMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 E SANGAMON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-1854
Mailing Address - Country:US
Mailing Address - Phone:217-753-8141
Mailing Address - Fax:217-753-8145
Practice Address - Street 1:1244 E SANGAMON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1854
Practice Address - Country:US
Practice Address - Phone:217-753-8141
Practice Address - Fax:217-753-8145
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
227.011485172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist